A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur

Abstract

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.

PIP: During August 1991 to July 1993, in Manipur State, India, social workers interviewed 488 intravenous drug users (IDUs) who were drug-free for at least 7 days and who had been institutionalized within the previous 6 months in 1 of 9 detoxification centers (the largest being the Manipur Central Jail) in Imphal city. They aimed to examine the extent of risky injecting behavior, determinants of safer injecting behavior, and any change in risky behavior since 1990. The research team provided HIV counseling after the interview. This counseling was in addition to routine counseling provided by the centers. Almost all (99%) subjects were male. The median age was 26 years. IDUs in this study were less likely to currently share needles than in 1990 (70% vs. 96%; p 0.01). IDUs in 1993 were less likely to report never cleaning needles than in 1990 (10% vs. 62%; p 0.01). Nevertheless, only 69% knew specifically the protective role of any type of cleaning. No IDU knew about the use of bleach to clean needles. The HIV prevalence rate among IDUs has increased from 56% to 80%. IDUs in 1993 were more likely to know that HIV is transmitted via sexual intercourse and by needle sharing than in 1990 (95% vs. 70% and 93% vs. 75%, respectively; p 0.01). About 70% of all IDUs in 1993 had undergone HIV testing. Knowing one's HIV status did not influence needle sharing (69.4% vs. 71% for not knowing). Knowledge of HIV transmission, educational status, or history of HIV testing or HIV status influenced unsafe needle sharing practices. When the researchers controlled for education, ethnicity, duration of drug use, and awareness about their HIV test result, only age less than 30 years was associated with sharing of unclean needles (83.4% vs. 16.6% for 30-44 year olds; odds ratio = 2.2; p = 0.0016). These findings suggest urgent and appropriate intervention in this high-risk group.